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7 tips for successful questionnaire design www.dhpresearch.comUnderstand the START AT THE END BIG picture Craft a CHOOSE good THE QUESTION GET THE question LAYOUT & SEQUENCING TYPE RIGHT Develop the structure PILOT & PERFECT THE QUESTIONNAIRE Copyright DHP Research 2012

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7 tips for successful questionnaire design www.dhpresearch.comINTRODUCTION Who is this guide for?Designing a patient survey questionnaire whether it’s For the healthcare professional, clinician and researcher who reliesto measure patient satisfaction or patient experience is on information on patient satisfaction, health and or experience,more than simply writing some questions expecting the choice and use of a well designed and validated questionnairepatients to understand them and provide reliable and is essential.valid answers. Designing a patient satisfaction or How will this guide help you?experience questionnaire involves initiating a By applying the 7 steps described here you will be assured thatrelationship with respondents that stimulates their your health survey questionnaire will be designed based on theseinterest and encourages them to provide the best first principles of questionnaire design and that with properanswers possible. planning will have greater confidence in the quality of informationCollecting information using a questionnaire to measure patient collected.satisfaction, experience and health is now common practice. There What’s ahead?is a variety of questionnaire types that can be used. Whichever Step-by-step, the following pages will lead you through the processway questionnaires are used and for whatever purpose, the same of designing a patient survey questionnaire that will help youdesign rules should apply in their construction to ensure that they leverage maximum results from you survey.are appropriate for their intended use and provide reliable andvalid data.Patient survey questionnaires designed with little thought will leadto the collection of unreliable and invalid information. Copyright DHP Research 2012

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1 7 tips for successful questionnaire design www.dhpresearch.comUNDERSTAND THE BIG PICTURE ExamplesIt is essential that the overall objectives of the patient survey are If the objectives of the survey questionnaire are, fordefined at the outset (the research question). This will include example, to gain an insight into the health status ofestablishing the purpose of the survey e.g. measuring patient homeless people, then a self-completion or telephonesatisfaction, experience and outcomes, clarifying the target administered questionnaire is not feasible. If, however,population the questionnaire will be administered to e.g. patient we wanted to find out the level of patient satisfaction ofgroup, disease type, how the information will be collected e.g. a sample of patients registered with a general practicepaper/pencil, interview, web and how that information will be used using a five-item questionnaire, this could be carried oute.g. improve patient experience. using either a self completion or a telephone interview. Availability of resources include costs, personnel to conduct interviews or handle administrative tasks, skill and time to develop and administer the questionnaire, data coding and entry, data analysis. Characteristics of the target population include their overall educational level and the accessibility to the respondents. If the potential respondents are geographically widely dispersed then face-to-face interviewing will be impractical. Copyright DHP Research 2012

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2 7 tips for successful questionnaire design www.dhpresearch.comSTART AT THE END Additional considerationsThe aims of the patient survey questionnaire will provide the basisfor the structure of the questionnaire and developing the content to The practical value of a questionnaire depends on the reliabilitycollect the information required to address the study aims e.g. and validity of the information it collects. Reliability refers to howpatient satisfaction or experiences of the different touch points of well data collected by using a questionnaire can be reproduced ofthe patient’s journey, access to treatment etc. which the more common indicator of reliability is test-retest reliability.Tailoring the content to meet the objectives of the patient surveyideally includes both a comprehensive review of the literature and Validity is how well the questionnaire measures what it is intendedthe undertaking of a small-scale qualitative study to identify the to measure. For a measure to be valid it must be reliable, butrange of behaviours, attitudes and issues relevant to the objectives remember something can be reliable without being valid.of the survey. A literature review will provide information on anyother studies which have been done on the topic, the current state “Without content validity no amount of statisticalof knowledge in the area, help build on or extend current work, manipulation will provide you with useful information”.identify methods of data collection, and highlight the content ofexisting questionnaires and any problems experienced. Copyright DHP Research 2012

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3 7 tips for successful questionnaire design www.dhpresearch.comDEVELOP THE STRUCTUREOnce the main areas of information that are required to meet theaims and objectives of the study are defined, the overall structureof the questionnaire can be developed e.g. questions relating to “Once thethe patient’s experience of and or satisfaction with treatment from main areas ofdiagnosis should be in a chronological order, general questions information thatshould be asked before specific questions. are required to meet the aims andThe topic areas and variables, and their relationships with other objectives of thevariables identified from the literature review and qualitative study are defined,research, need to be included in the questionnaire. These should the overallbe listed and decisions made on how they can be measured. structure of theFrom this, the detailed design work can start, such as formulating questionnaire canthe specific questions, deciding on the sequence of questioning and be developed”listing answer categories, adding instructions, and signposts andquestion skip instructions if its an interview administeredquestionnaire. Copyright DHP Research 2012

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4 7 tips for successful questionnaire design www.dhpresearch.comCHOOSE THE QUESTION TYPEChoosing the correct type of question for your health survey will Question examplesinvolve making decisions such as whether to use an open or closed The Multiple Choice Scale Which of the following best describes how you travelled to this practice today?question, a ‘don’t know’ response option, rating scales or grids Bus Trainetc. First however, it is important to specify whether the questions Taxiare about the patient’s attitude, behaviours, experiences etc. Car Walked Other The Rating Scale How helpful did you find the practice receptionist? Very helpful Somewhat helpful Neither helpful nor unhelpful Somewhat unhelpful Very unhelpful The Sematic Differential Scale How would you rate your overall health over the past seven days? 1. Much better than usual 2. Somewhat better than usual 3. About the same as usual 4. Somewhat worse than usual 5. Much worse than usual Notice that unlike the rating scale, the semantic differential scale does not have a neutral orHint: Response options must be available that reflect the reality of the middle selection. A person must choose, to a certain extent, one or the other adjective.range of responses Copyright DHP Research 2012

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5 7 tips for successful questionnaire design www.dhpresearch.comCRAFT A GOOD QUESTION Aspects of good word craftingThe principle aim in writing a survey question is to ensure • Use simple language, avoid the use of technical terms, professional jargon and abbreviationsthat it means the same to all the respondents, who shouldbe able to respond with as accurate a response as possible. • Avoid words that may have more than one meaning (e.g. dinner)This will include for example: using simple language, • Avoid questions that are not sufficiently specific (e.g. How well do you manage your diabetes?)avoiding the use of technical terms and abbreviations aswell as only ask questions that are relevant to the • Avoid ambiguity (e.g. What kind of day has it been for you?)respondent. • Keep the maximum number of words in a question to approximately 20 • Avoid double-barrelled questions (e.g. How do you feel about the treatment you haveA number of factors that need to be addressed when been receiving for your present illness, and the doctors who are treating you?)designing patient survey questions include: • Avoid double negatives – a negative statement followed by a disagree response (e.g. I feel there is no one I’m close to – disagree).Memory Avoid over-taxing the respondent’s memory • Avoid leading questions (e.g. Many patients now days think that waiting are too long. Do you?)Motivation Ask questions that are relevant to the • Avoid the use of loaded words and concepts (e.g. those which are emotionally coloured and suggest a feeling of approval or disapproval)respondent • Avoid the use of presuming questions (e.g. How long did you have to wait the last time you visited your local accident and emergency department?)Communication Ensure what we are asking the respondentis clearly communicated Copyright DHP Research 2012

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6 7 tips for successful questionnaire design www.dhpresearch.comGET THE LAYOUT & SEQUENCING RIGHT Some key recommendationsAttention to the design and layout of a patient satisfaction or • Specific questions should follow on from general Questionsexperience questionnaire is an important stage in its development • Demographic questions (e.g. age, sex, educationand includes length, question and answer format, font, and race) should be placed at the end of the questionnaireinstructions and routing. • Whenever possible questions should be ordered from easy to difficult in the questionnaire.The key is to make the flow through the questionnaire logical to • Questions should be blocked by topic.the patient. • Avoid splitting a question or its response options across two pages • The apparent relevance and salience of opening questions can influenceFor both questions and response categories a consistent format respondents’ motivation to complete the questionnaire. Therefore, relevant and salient questions should be placed close to the front.should be kept throughout the questionnaire and the naturalreading style of left to right should be considered when placingheadings, codes or instructions. Whenever possible graphics shouldbe used to steer the patient or interviewer through thequestionnaire or indicate skip patterns. Copyright DHP Research 2012

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7 7 tips for successful questionnaire design www.dhpresearch.comPILOT & PERFECT THE Some final pointsQUESTIONNAIRE • Using a questionnaire to collect information for studies orPre-testing the patient questionnaire can highlight any surveys is now common practice.problems with it, including length, understanding, • The mode of questionnaire administration is the first choice tomissing questions etc. Pre-tests can be carried out be made.using focus groups) and, more recently, cognitive • The wording and ordering of questions is central to the reliability and validity of the patient’s response.aspects of survey methodology (CASM), which draws • A well-designed questionnaire can simplify the tasks of theon the theories of cognitive psychology and the use of patient, interviewer and data processor as well as producing valid and reliable data.cognitive laboratory techniques to improve • Pre-testing and piloting the questionnaire is an integral part ofquestionnaire design. its development.Pilot studies tests the whole administrative procedure of using thequestionnaire in a smaller but representative sample of theparticipants before the main study. Here the aim is to test thewhole questionnaire, letter of introduction, instructions toparticipants, reminder letters etc. It is a small-scale test of themain study. Copyright DHP Research 2012

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